Abstract
BackgroundUniversal screening of children for dyslipidemia and other cardiovascular risk factors has been recommended. Given the clustering of cardiovascular risk factors within families, one benefit of screening adolescents may be to identify “at-risk” families in which adult members might also be at elevated risk and potentially benefit from medical evaluation.MethodsCross-sectional study of grade 9 students evaluating adiposity, lipids and blood pressure. Data collected by Heart Niagara Inc. through the Healthy Heart Schools’ Program. Parents completed questionnaires, evaluating family history of dyslipidemia, hypertension, diabetes and early cardiovascular disease events in parents and siblings (first-degree relatives), and grandparents (second-degree relatives). Associations between positive risk factor findings in adolescents and presence of a positive family history were assessed in logistic regression models.ResultsN = 4014 adolescents ages 14–15 years were screened; 3467 (86 %) provided family medical history. Amongst adolescents, 4.7 % had dyslipidemia, 9.5 % had obesity, and 3.5 % had elevated blood pressure. Central adiposity (waist-to-height ratio ≥0.5) in the adolescent was associated with increased odds of diabetes in first- (OR:2.0 (1.6–2.6), p < 0.001) and second-degree relatives (OR:1.3 (1.1–1.6), p = 0.002). Dyslipidemia was associated with increased odds of diabetes (OR:1.6 (1.1–2.3), p < 0.001), hypertension (OR:2.2 (1.5–3.2), p < 0.001) and dyslipidemia (OR:2.2 (1.5–3.2),p < 0.001) in first degree relatives. Elevated blood pressure did not identify increased odds of a positive family history.ConclusionsPresence of obesity and/or dyslipidemia in adolescents identified through a universal school-based screening program is associated with risk factor clustering within families. Universal pediatric cardiometabolic screening may be an effective entry into reverse cascade screening.
Highlights
Universal screening of children for dyslipidemia and other cardiovascular risk factors has been recommended
We sought to evaluate the association between pediatric cardiometabolic risk factors identified through universal school-based cardiometabolic screening and the presence of elevated cardiometabolic risk factors and cardiovascular disease (CVD) in family members
The findings of our study indicate that cardiometabolic risk factors identified through universal school-based screening of adolescents is associated with the presence of risk factors in family members
Summary
Universal screening of children for dyslipidemia and other cardiovascular risk factors has been recommended. Landmark autopsy studies have shown that, in children who died accidentally, there was an exponential increase in the extent of their atherosclerotic burden as the number of cardiovascular risk factors increased [1,2,3,4]. Cardiovascular risk factors often cluster within members of families, with both genetic and common environmental/behavioral determinants [8, 9] Amongst adults, those between 18 and 44 years old have the lowest health-care utilization [10], creating the potential for delayed identification and management of cardiometabolic risk factors and disease. We sought to evaluate the association between pediatric cardiometabolic risk factors identified through universal school-based cardiometabolic screening and the presence of elevated cardiometabolic risk factors and cardiovascular disease (CVD) in family members
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